Paper and electronic versions of an implantable cardioverter defibrillator checklist to ensure compliance with Medicare coverage rules.
- Simplifies compliance with Medicare National Coverage Determinations.
- Provides guidance and increases physician confidence on the appropriateness of implantation of implantable cardioverter defibrillators.
- Compatible with current electronic medical record systems.
Implantable cardioverter defibrillators (ICDs) can be life-saving in patients with advanced heart disease and who are at risk of life-threatening heart rhythm disorders. Due to the high cost of this procedure, the Centers for Medicare and Medicaid Services issued the Medicare’s National Coverage Determinations (NCD). The NCD specifies the exact clinical scenarios for which Medicare will cover the placement of ICD’s for Medicare beneficiaries. Since 2005, Medicare has audited hospitals and cardiology physicians across the United States and found that many implanted ICDs do not meet Medicare’s NCD requirements. In most cases, this non-compliance is due to inadequate documentation and has resulted in Medicare taking federal action, requiring many hospitals to pay back Medicare three-fold for ‘inappropriate” or “fraudulent” ICD implants.
Emory personnel have developed an implantable cardioverter defibrillator (ICD) checklist to ensure physicians are compliant with Medicare coverage rules for implanting ICDs. The team has developed both a paper version and electronic version which can be used with electronic medical record systems. The checklist greatly simplifies the Medicare National Coverage Determinations (NCD), making it easier to follow. It also provides guidance on the appropriateness of ICD implantation in clinical scenarios not covered by the Medicare NCD.
Both paper and electronic versions have been developed and are in use in Emory hospitals.